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Do not use this form for a Tax Sheltered Annuity

Do not use this form for a Tax Sheltered Annuity 2026

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The document is a Periodic Partial Withdrawal/Partial Withdrawal Request Form for New York Life Insurance and Annuity Corporation (NYLIAC). It provides instructions for policyowners on how to request partial withdrawals from their variable annuity policies, including details on completing the form, tax implications, and required signatures. The form outlines options for one-time or periodic withdrawals, necessary documentation for large amounts, and the impact of withdrawals on policy values and benefits. It emphasizes the importance of consulting tax advisors regarding potential penalties and tax withholding.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date and your policy number at the top of the form. Ensure that all information is accurate.
Read through the instructions carefully, especially noting that this form should not be used for a Tax Sheltered Annuity.
If you wish to set up a Periodic Partial Withdrawal Arrangement, complete Sections A, B, and D through F. Be sure to specify the frequency and amount of withdrawals.
For a one-time Partial Withdrawal, fill out Sections B through F. Indicate the amount you wish to withdraw and ensure it meets the minimum requirement.
Sign and date Section F of the form. If there are joint owners, all must sign. Remember to provide your Tax Identification Number.
If withdrawing over $50,000, include a notarized confirmation or Medallion Signature Guarantee.

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